Active NPI
Eric Charles Clark, LLBSW
- Social Worker
- Kalamazoo, MI
National Provider Identifier
1295283430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802088506
- Practice address
- 1608 Lake St
Kalamazoo, MI 49001-3170 - Phone
- (269) 344-0202
- Fax
- (269) 373-2939
- NPI assigned
- Sep 16, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802088506 | MI | Primary |
Addresses
Primary practice location
1608 Lake St
Kalamazoo, MI 49001-3170
Mailing address
1608 Lake St
Kalamazoo, MI 49001-3170
Phone (269) 344-0202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802088506 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473984000000",
"number": "1295283430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1608 LAKE ST",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490013170",
"telephone_number": "269-344-0202",
"fax_number": "269-373-2939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1608 LAKE ST",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490013170",
"telephone_number": "269-344-0202",
"fax_number": "269-373-2939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ERIC",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "LLBSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-16",
"last_updated": "2016-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802088506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.